Ann Thorac Surg. 2026 May 23:S0003-4975(26)00465-0. doi: 10.1016/j.athoracsur.2026.05.012. Online ahead of print.
ABSTRACT
BACKGROUND: Little is known about the impact of prior COVID-19 infection in an organ donor on the viability of pediatric donor hearts. In a national cohort, we assess if COVID-19+ donor status impacts outcomes after cardiac transplantation.
METHODS: We performed a retrospective review of the United Network for Organ Sharing databases for all pediatric heart transplants since the inception of COVID-19 data collection (April 2020-December 2024). A COVID-19+ donor was defined as "ever having a positive upper or lower respiratory SARS-CoV-2 nucleic acid amplification or antigen test within 21 days of Recovery". We utilized a nearest neighbor 1:1 propensity score match to adjust for differences between recipients of COVID-19+ and non-COVID-19+ donor hearts.
RESULTS: Among 2,245 pediatric heart transplants, 100/2,245=4.5% utilized COVID-19+ donor hearts. These recipients had lower BMI(16.8 versus 17.8 kg/m2,p=0.02), but were otherwise similar in age (6 versus 8 years,p=0.09) and congenital heart disease prevalence (53% versus 51.5%,p=0.85). In matched analyses (COVID-19+ versus non-COVID-19+), rates of postoperative stroke (1% versus 5%,p=0.22), dialysis (8% versus 6%,p=0.78), and acute rejection (9% versus 14%,p=0.39) did not differ between groups. COVID-19 was not reported as a cause of death in any patients who died with a transplanted COVID-19+ heart. One-year post-transplant survival was 91.9%(95%CI=86.2-97.9%) for COVID-19+ donors versus 93.2%(95%CI-88.1-98.6%) for non-COVID-19+ donors (log-rank p=0.71). COVID-19+ donor status was not associated with increased one-year mortality(OR=0.88,95%CI=0.36-1.85;p=0.76).
CONCLUSIONS: Pediatric heart transplants from COVID-19+ donors demonstrated comparable outcomes to non-COVID-19+ donors. These findings support the safe use of COVID-19+ donor hearts, though longer follow-up is needed.
PMID:42178087 | DOI:10.1016/j.athoracsur.2026.05.012